Preoperative management of congestive heart failure in neonates: the closed hood

Abstract In this study we report the results of the use of a closed hood with no external administration of CO 2 to increase pulmonary vascular resistance by lowering the inspired fraction of oxygen (FiO 2 ) and raising the inspired fraction of carbon dioxide (FiCO 2 ) in patients with congenital heart disease and increased pulmonary blood flow. Between December 1995 and May 1996, 9 neonates (F:5, M:4) were admitted. Each study patient was assigned to clinical classes using a 1 to 4 classification. Ages ranged between 2 and 30 days (mean 18), weight between 2.25 and 3.65 kg (mean 2.89). A plastic hood, closed on the top with a plastic membrane and with the gas entrance open to room air was placed over the head of the patients. Patients increase pCO 2 by rebreathing their own expired CO 2 . After 24 h of the onset of the treatment the media of points of congestive heart failure 1 to 4 classification decrease from a mean of 4 to a mean of 2.28±0.44 ( p =0.001). A statistically significant improvement in symptoms and lowering of pO 2 and pH while raising pCO 2 has been demonstrated in this study.